Tissue resection device

ABSTRACT

Disclosed herein is a medical device. The medical device includes outer, middle, and inner tubular members. The outer tubular member has a proximal end and a distal end. The middle tubular member has a proximal end and a distal end. The middle tubular member is configured to be received within the outer tubular member and capable of being rotatable relative to the outer tubular member. The inner tubular member is configured to be received within the middle tubular member and capable of reciprocating and also capable of being rotatable relative to the middle tubular member. The inner tubular member is configured to reciprocate and rotate while the middle tubular member and the outer tubular member are configured to be stationary. The middle tubular member is configured to be rotatable relative to the outer tubular member while the inner tubular member is configured to be stationary.

CROSS REFERENCE TO RELATED APPLICATION

This is a continuation patent application of U.S. patent applicationSer. No. 15/656,057 filed on Jul. 21, 2017, which is hereby incorporatedby reference in its entirety.

BACKGROUND Field of the Invention

The invention relates to a tissue resection device, and morespecifically relates to a tissue resection blade assembly.

Brief Description of Prior Developments

Conventional products (such as from Truclear [S&N Medtronic] and Myosure[Hologic]) participate in the treatment of resecting sub-mucosalnon-cancerous growths of polyps and fibroids tissues in the uterinecavity. The areas where these unwanted tissues grow can be anywhere onthe endometrium surfaces of the uterus and on the inside wall of thefundus on the upper third of the uterus.

Many of the conventional configurations require multiple blades. Forexample, these conventional configurations generally comprise one ormore dedicated blades which are designated as an incisor blade which isgenerally used for resecting hard to reach areas, and another dedicatedblade for resecting larger and harder tissues.

Accordingly, as the conventional designs generally result in variouslimitations and disadvantages (as described above), there is a need toprovide improved and reliable product configurations.

SUMMARY

In accordance with one aspect of the invention, a medical device isdisclosed. The medical device includes an outer tubular member, a middletubular member, and an inner tubular member. The outer tubular memberhas a proximal end and a distal end. The middle tubular member has aproximal end and a distal end. The middle tubular member is configuredto be received within the outer tubular member and capable of beingrotatable relative to the outer tubular member. The inner tubular memberis configured to be received within the middle tubular member andcapable of reciprocating and also capable of being rotatable relative tothe middle tubular member. The inner tubular member is configured toreciprocate and rotate while the middle tubular member and the outertubular member are configured to be stationary. The middle tubularmember is configured to be rotatable relative to the outer tubularmember while the inner tubular member is configured to be stationary.

In accordance with another aspect of the invention, a cutting device forcutting tissue is disclosed. The device includes an outer tubularmember, a middle tubular member, and an inner tubular member. The outertubular member has a proximal end, a distal end, and an opening disposedat the distal end. The middle tubular member has a proximal end, adistal end, and an opening disposed at the distal end. The middletubular member is configured to be received within the outer tubularmember and capable of being rotatable relative to the outer tubularmember. The inner tubular member is configured to be received within themiddle tubular member and capable of reciprocating and also capable ofbeing rotatable relative to the middle tubular member. The opening ofthe outer tubular member and the opening of the middle tubular memberare configured to form a cutting tool when the middle tubular memberrotates relative to the outer tubular member while the inner tubularmember is configured to be stationary at the same time.

In accordance with another aspect of the invention, a cutting device forcutting tissue is disclosed. The device includes an outer tubularmember, a middle tubular member, and an inner tubular member. The outertubular member has a proximal end, a distal end, and an opening disposedat the distal end. The middle tubular member has a proximal end, adistal end, and an opening disposed at the distal end. The middletubular member is configured to be received within the outer tubularmember and capable of being rotatable relative to the outer tubularmember. The inner tubular member is configured to be received within themiddle tubular member and capable of reciprocating and also capable ofbeing rotatable relative to the middle tubular member. The middletubular member and the outer tubular member are configured to bestationary when the inner tubular member reciprocates and rotatesrelative to the middle tubular member while the opening of the outertubular member and the opening of the middle tubular member areconfigured to form a closed configuration at the same time such that noliquid can flow through the two openings.

In accordance with another aspect of the invention, a cutting device forcutting tissue is disclosed. The device includes an outer tubularmember, a middle tubular member, an inner tubular member, a firstopening, and a second opening. The outer tubular member has a proximalend and a distal end. The middle tubular member has a proximal end and adistal end. The middle tubular member is configured to be receivedwithin the outer tubular member and capable of being rotatable relativeto the outer tubular member. The inner tubular member is configured tobe received within the middle tubular member and capable ofreciprocating and also capable of being rotatable relative to the middletubular member. The first opening having a cutting surface disposed atthe distal end of the outer tubular member. The second opening having acutting surface disposed at the distal end of the middle tubular member.The first opening and the second opening are configured to form onecutting tool while the inner tubular member is configured to bestationary. The inner tubular member is configured to reciprocate androtate while the middle tubular member and the outer tubular member areconfigured to be stationary.

In accordance with another aspect of the invention, a cutting device forcutting tissue is disclosed. The device includes an outer tubularmember, a middle tubular member, an inner tubular member, a firstopening, a first window, a second opening, and a second window. Theouter tubular member has a proximal end and a distal end. The middletubular member has a proximal end and a distal end, the middle tubularmember configured to be received within the outer tubular member andcapable of being rotatable relative to the outer tubular member. Theinner tubular member is configured to be received within the middletubular member and capable of reciprocating and also capable of beingrotatable relative to the middle tubular member. The first opening has acutting surface disposed at the distal end of the outer tubular member.The first window is disposed between the distal, end and the proximalend of the outer tubular member. The second opening has a cuttingsurface disposed at the distal end of the middle tubular member. Thesecond window is disposed between the distal end and the proximal end ofthe middle outer tubular member. The first opening and the secondopening are configured to form a cutting tool when the middle tubularmember rotates relative to the outer tubular member. The inner tubularmember is configured to form another cutting tool while it reciprocatesand rotates relative to the middle tubular member when it is exposed bya superimposition of the first window and the second window.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing aspects and other features of the invention are explainedin the following description, taken in connection with the accompanyingdrawings, wherein:

FIG. 1 is a side view of a medical device incorporating features of theinvention;

FIG. 2 is a partial perspective view of a blade assembly of the medicaldevice shown in FIG. 1;

FIG. 3 is a partial section view of the blade assembly shown in FIG. 2;

FIG. 4 is an enlarged partial section view of the portion identified as“4” in FIG. 3;

FIG. 5 is a partial side view of an outer blade of the blade assemblyshown in FIG. 2;

FIG. 6 is a partial side view of a middle blade of the blade assemblyshown in FIG. 2;

FIG. 7 is a partial side view of an inner blade of the blade assemblyshown in FIG. 2;

FIG. 8 shows partial perspective views of the blade assembly shown inFIG. 2 in an oscillation mode;

FIG. 9 shows partial perspective views of the blade assembly shown inFIG. 2 in a reciprocation and rotation mode;

FIG. 10 shows top, left, and side views of the outer blade shown in FIG.5;

FIG. 11 shows top, left, bottom, and side views of the middle bladeshown in FIG. 6;

FIG. 12 shows top and left views of the inner blade shown in FIG. 7;

FIG. 13 is a partial cross-section view of the medical device shown inFIG. 1;

FIG. 14 is a perspective view of a portion of a housing of the medicaldevice shown in FIG. 1, 13;

FIG. 15 is a perspective view of an inner blade driver and the innerblade of the medical device shown in FIG. 1, 13; and

FIGS. 16-18 show partial perspective views of the inner blade drivershown in FIG. 15.

DETAILED DESCRIPTION

Referring to FIG. 1, there is shown a side view of a medical device 10incorporating features of the invention. Although the invention will bedescribed with reference to the exemplary embodiments shown in thedrawings, it should be understood that the invention can be embodied inmany alternate forms of embodiments. In addition, any suitable size,shape or type of elements or materials could be used.

In the embodiment shown in FIG. 1, the medical device (or cuttingdevice) 10 includes a handpiece 12 and a disposable blade assembly 14which is removably attachable to the handpiece 12. In alternateembodiments, the medical device may comprise a stand-alone disposableblade assembly. Additionally, any other suitable configuration having ablade assembly may be provided.

Referring now also to FIG. 2, there is shown a partial perspective viewof the blade assembly 14. The blade assembly 14 comprises an outer blade16, a middle blade 18, and an inner blade 20. The blades 14, 16, 18 eachhave a general tubular shape with different diameters configured suchthat the middle blade 18 is received by the outer blade 16, and suchthat the inner blade 20 is received by the middle blade 18 (see crosssection view of FIG. 3 and the enlarged partial cross section view ofFIG. 4 [with the identified enlarged portion labeled as “4” in FIG. 3]).Additionally, the middle blade 18 is configured to be rotatable withinthe outer blade 16 (see arrow 22), and the inner blade 20 is configuredto be rotatable (see arrow 24) within the middle blade 18 and alsocapable of reciprocation (see arrow 26) within the middle blade 18. Thisconfiguration of the blade assembly 14 provides a rotary reciprocatingblade window 52 and an oscillating blade window 54 proximate the end ofthe blade assembly 14.

Referring now to FIG. 5, the outer blade 16 is stationary and fixed allthe time during operation and comprises a general tubular shape having aproximal end and a distal end 30. The outer blade further comprises afirst window (or opening) 32 and a second window (or opening) 34. Thefirst window 32 is configured to be aligned with therotary/reciprocating inner blade 20. The second window 34 is configuredto be aligned with oscillating middle blade 18. The second window 34 isat the distal end 30, and the first window is proximate the distal end30 but spaced from the second window 34. According to various exemplaryembodiments, edges of the window 32, 34 may comprise serrations and/orknife edges, however any suitable edge surface may be provided.

Referring now to FIG. 6, the middle blade 18 comprises a general tubularshape having a proximal end and a distal end 38. The middle bladefurther comprises a first window (or opening) 40 and a second window (oropening) 42. The first window 40 is configured to be aligned with thefirst window 32 of the outer blade 16 and further provides a reliefwindow for the rotary/reciprocating inner blade 20. The second window 42provides an oscillating blade that has a “cutting blade” window at theend when aligned with the second window 34 of the outer blade 16.Similar to the outer blade 16, the second window 42 is at the distal end38, and the first window 40 is proximate the distal end 38 but spacedfrom the second window 42. According to various exemplary embodiments,edges of the window 40, 40 may comprise serrations and/or knife edges,however any suitable edge surface may be provided. The middle blade isgenerally configured for cutting hard to reach tissues inside the uteruscavity. According to various embodiments, the cutting profile of thewindow 42 is similar to ENT and Arthroscopy shaver blades.

Referring now also to FIG. 7, the inner blade forms arotary/reciprocating blade and comprises a general tubular shape havinga proximal end 44 and a distal end 46.

Referring now also to FIG. 8, during operation of an oscillation mode orsingle rotation mode, the inner blade 20 is in the full closed positionfor the middle blade 18 to start oscillating or rotating in onedirection (see arrows 48, 50). This provides for the rotaryreciprocating blade window 52 to remain closed while the middle blade 18oscillates back and forth so that the oscillating blade window 54 opensand closes. This cutting operation is similar to ENT and Arthroscopyshaver blades. It should be noted that according to various exemplaryembodiments, the middle blade 18 is always closed when not in-use andstops at the closed position when turned-off in order for the fluidpressure to be maintained and not depleted unnecessarily. The middleblade may enable the oscillation or one direction rotation mode of theone blade assembly.

Referring now also to FIG. 9, during operation of a reciprocation androtation mode, the inner blade 20 is the rotary/reciprocating cuttingblade. It is also the blade that rotates and reciprocates at the sametime and performs the cutting during the forward stroke 56. In thismode, the oscillating blade window 54 remains in the close position (dueto the opposite alignment of the windows 34, 42). Similar to traditionalTissue Removal Devices in the market, at this forward stroke, the innerblade rotates and that causes the slicing/cutting action to the tissuewhile continually providing suction function in the forward 56 andreturn 58 stroke. The inner blade 20 always stops at the closed (forwardposition) when off or not in use to prevent depletion of fluid pressure.

Referring now also to FIGS. 10-12, additional views of the outer blade16, the middle blade 18, and the inner blade 20 are shown.

FIG. 10 illustrates a top view, a side view, and a left view of theouter blade 16. According to one or more exemplary embodiments, theouter blade 16 may comprise dimensions as follows: A (14.000 in., 355.60mm), B (0.172 in., 4.37 mm), C (0.605 in., 15.37 mm), D (0.152 in., 3.86mm), E (0.046 in., 1.17 mm), F (0.050 in., 1.27 mm), G (0.200 in., 5.08mm), H (0.061 in., 1.55 mm), I (0.027 in., 0.69 mm), J (0.008 in., 0.20mm). It should be noted that these dimensions are merely exemplary andshould be considered as non-limiting examples.

FIG. 11 illustrates a top view, a side view, a bottom view, and a leftview of the middle blade 18. According to one or more exemplaryembodiments, the middle blade may comprise dimensions as follows: A(15.000 in., 381.00 mm), B (0.156 in., 3.96 mm), C (0.598 in., 15.19mm), D (0.134 in., 3.40 mm), E (0.038 in., 0.97 mm), F (0.050 in., 1.27mm), G (0.200 in., 5.08 mm), H (0.138 in., 3.51 mm), I (0.053 in., 1.35mm), J (0.030 in., 0.76 mm), K (0.008 in., 0.20 mm). It should be notedthat these dimensions are merely exemplary and should be considered asnon-limiting examples.

FIG. 12 illustrates a top view and a left view of the inner blade 20.According to one or more exemplary embodiments, the inner blade maycomprise dimensions as follows: A (17.000 in., 431.80 mm), B (0.141 in.,3.58 mm), C (0.006 in., 0.15 mm), D (Chamfer dimensions as desired tocreate sharp end). It should be noted that these dimensions are merelyexemplary and should be considered as non-limiting examples.

Referring now also to FIG. 13, there is shown a cross-section view ofthe cutting device 10. According to one or more exemplary embodiments,the cutting device comprises an inner blade driver 60, a middle bladedriver 62, an outer blade fixing member 64, a rotatable shaft 66, afirst one way bearing 68, a second one way bearing 70, and a movablemember 72.

The inner blade driver 60 is connected to an end of the inner blade 20and is configured to rotate and reciprocate the inner blade 20. Themiddle blade driver 62 is connected to the middle blade 18 and isconfigured to rotate the middle blade 18 in one direction. The outerblade fixing member 64 is connected to the outer blade 16 and isconfigured to maintain the outer blade 16 in a stationary position.

The rotatable shaft 66 is substantially parallel to and adjacent theblades 16, 18, 20 and is configured to be rotatable in a clockwise (CW)direction 74 and a counterclockwise (CCW) direction 76. The first oneway bearing 68 is mounted on one end of the shaft 66 and contacts theinner blade driver 60. The second one way bearing 70 is mounted on anopposite end of the shaft 66 and contacts the middle blade driver 62.

At least a portion of the movable member 72 is between the inner bladedriver 60 and the middle blade driver 62 and is configured to be movablebetween a forward position 78 (when moved in direction 80) and a rearposition 82 (when moved in direction 84).

When the movable member 72 is in the forward position 78, this locks themiddle blade 18 in the closed position and also causes the device 10 torotate the shaft 66 in the CCW direction 76. With the shaft 66 rotatingin the CCW direction 76, this causes the first one way bearing 68 toengage with and rotate the inner blade driver 60, while at the same timecausing the second one way bearing 70 to disengage with the middle bladedriver 60 (and provide no turning force to the middle blade driver 60).

When the movable member 72 is in the rear position 82, this locks theinner blade 20 in the closed position and also causes the device 10 torotate the shaft 66 in the CW direction 74. With the shaft 66 rotatingin the CW direction 74, this causes the second one way bearing 70 toengage with and rotate the middle blade driver 62, while at the sametime causing the first one way bearing 68 to disengage with the innerblade driver 60 (and provide no turning force to the inner blade driver60).

Furthermore, the inner blade driver (or translation piece) 60 isconfigured to reciprocate through the housing 100 with projectingmembers 96 alternating back and forth through a double helical sweepconfiguration 98 on the housing 100 (see also FIGS. 14, 15).Additionally, element 86 is configured to be a fixed component of asuction barb fitting, while the O-ring provides a seal when the innerblade driver 60 reciprocates back and forth. Referring now also to FIGS.16-18, each projecting member 96 is configured to be movably connectedto the inner blade driver 60. Each projecting member 96 comprises aconnecting portion 102 and a projecting portion 104. The connectingportion 102 is configured to be received at a receiving area 106 of theinner blade driver 60. The projecting portion 104 comprises a generalarc or curved shape and is configured to be received at the doublehelical sweep 98 of the housing 100. As shown in FIGS. 16 and 17, due tothe curved shape of the projecting portion extending along approximatelyhalf of the circumference of the inner blade driver 60, one of theprojecting members 96 is configured to be received at the double helicalsweep 98 of one side of the housing 100 and the other one of theprojecting members 96 is configured to be received at the double helicalsweep 98 of the other side of the housing 100. The projecting members 96are configured to pivot (at the movable connection between theconnecting portion 102 and the receiving area 106) at an angle thatfollows the double helical sweep pitch angle in order to reciprocate androtate the inner blade driver 60 back and forth. When the projectingmembers 96 move forward through the double helical sweep 98, the innerblade driver is configured to move from a first position 88 to a secondposition 90, which in turn moves the inner blade from an open position92 to a closed position 94. When the projecting members 96 move backthrough the double helical sweep 98, the inner blade driver isconfigured to move from the second position 90 to the first position 88,which in turn moves the inner blade 20 from the closed position 94 tothe open position 92.

While the one or more exemplary embodiments have been described above inconnection with the configuration shown in FIG. 13, one skilled in theart will appreciate that the various exemplary embodiments are notnecessarily so limited and that alternate configurations for driving theblades could be provided. For example, in some embodiments the middleblade driver may be configured to provide for one direction rotationonly of the middle blade (with no oscillation), while in otherembodiments the middle blade driver may provide for oscillation only oroscillation and rotation of the middle blade.

Technical effects of any one or more of the exemplary embodimentsprovide significant advantages over conventional configurations (such asblades for Hysterescopic Morcellation or Tissue Removal devices) havingmultiple blade assemblies. The exemplary embodiment disclosed hereinprovides a very simple construction where one blade assembly is able toaccommodate all different versions (of the different blade assemblies)that the competitors offer. This one blade assembly can function in twodifferent independent modes such as oscillation mode andreciprocation/rotation mode to provide a Tissue Resection Blade for hardto reach polyps and fibroids.

Additional technical effects of any one or more of the exemplaryembodiments eliminate the need for multiple blade types as descriedabove. This will enable the GYN surgeon, for example, to not have toswitch back and forth to different blades during the operation therebysaving procedure time. The hospital or healthcare provider facility willalso save on their inventory by stocking one single blade assembly SKUinstead of multiple blades or blade assemblies. The various exemplaryembodiments may also be applicable in other shaver operation(s) such asin ENT or Arthroscopy.

Below are provided further descriptions of various non-limiting,exemplary embodiments. The below-described exemplary embodiments may bepracticed in conjunction with one or more other aspects or exemplaryembodiments. That is, the exemplary embodiments of the invention, suchas those described immediately below, may be implemented, practiced orutilized in any combination (e.g., any combination that is suitable,practicable and/or feasible) and are not limited only to thosecombinations described herein and/or included in the appended claims.

In one exemplary embodiment, a medical device, the device comprising: anouter tubular member having a proximal end and a distal end; a middletubular member having a proximal end and a distal end, the middletubular member configured to be received within the outer tubular memberand capable of being rotatable relative to the outer tubular member; andan inner tubular member configured to be received within the middletubular member and capable of reciprocating and also capable of beingrotatable relative to the middle tubular member; wherein the innertubular member is configured to reciprocate and rotate while the middletubular member and the outer tubular member are configured to bestationary, and wherein the middle tubular member is configured to berotatable relative to the outer tubular member while the inner tubularmember is configured to be stationary.

A device as above wherein the outer tubular member comprises a firstopening, wherein the middle tubular member comprises a second opening,and wherein the first opening is aligned with the second opening.

A device as above wherein the outer tubular member comprises a firstwindow between the first opening and the proximal end, wherein themiddle tubular member comprises a second window between the secondopening and the proximal end.

A device as above wherein the first window and the second window arealigned with each other.

In another exemplary embodiment, a cutting device for cutting tissue,the device comprising: an outer tubular member having a proximal end, adistal end, and an opening disposed at the distal end; a middle tubularmember having a proximal end, a distal end, and an opening disposed atthe distal end, the middle tubular member configured to be receivedwithin the outer tubular member and capable of being rotatable relativeto the outer tubular member; and an inner tubular member configured tobe received within the middle tubular member and capable ofreciprocating and also capable of being rotatable relative to the middletubular member; wherein the opening of the outer tubular member and theopening of the middle tubular member are configured to form a cuttingtool when the middle tubular member rotates relative to the outertubular member while the inner tubular member is configured to bestationary at the same time.

A device as above wherein the outer tubular member is configured toremain stationary during operation.

A device as above wherein the outer tubular member comprises a firstwindow between the opening and the proximal end, wherein the middletubular member comprises a second window between the opening and theproximal end.

A device as above wherein the first window and the second window arealigned with each other.

In another exemplary embodiment, a cutting device for cutting tissue,the device comprising: an outer tubular member having a proximal end, adistal end, and an opening disposed at the distal end; a middle tubularmember having a proximal end, a distal end, and an opening disposed atthe distal end, the middle tubular member configured to be receivedwithin the outer tubular member and capable of being rotatable relativeto the outer tubular member; and an inner tubular member configured tobe received within the middle tubular member and capable ofreciprocating and also capable of being rotatable relative to the middletubular member; wherein the middle tubular member and the outer tubularmember are configured to be stationary when the inner tubular memberreciprocates and rotates relative to the middle tubular member while theopening of the outer tubular member and the opening of the middletubular member are configured to form a closed configuration at the sametime such that no liquid can flow through the two openings.

A device as above wherein the outer tubular member comprises a firstwindow between the first opening and the proximal end, wherein themiddle tubular member comprises a second window between the secondopening and the proximal end.

A device as above wherein the first window and the second window arealigned with each other.

A device as above wherein the distal end of the middle tubular member isbetween the proximal end and distal end of the outer tubular member.

In another exemplary embodiment, a cutting device for cutting tissue,the device comprising: an outer tubular member having a proximal end anda distal end; a middle tubular member having a proximal end and a distalend, the middle tubular member configured to be received within theouter tubular member and capable of being rotatable relative to theouter tubular member; an inner tubular member configured to be receivedwithin the middle tubular member and capable of reciprocating and alsocapable of being rotatable relative to the middle tubular member; afirst opening with cutting surface disposed at the distal end of theouter tubular member; and a second opening with cutting surface disposedat the distal end of the middle tubular member; wherein the firstopening and the second opening are configured to form one cutting toolwhile the inner tubular member is configured to be stationary, andwherein the inner tubular member is configured to reciprocate and rotatewhile the middle tubular member and the outer tubular member areconfigured to be stationary.

A device as above wherein the first opening and the second opening arealso configured to form a closed configuration at the same time suchthat the two openings are liquid tight.

A device as above wherein the outer tubular member comprises a firstwindow between the first opening and the proximal end, wherein themiddle tubular member comprises a second window between the secondopening and the proximal end.

A device as above wherein the first window and the second window arealigned with each other.

In another exemplary embodiment, a cutting device for cutting tissue,the device comprising: an outer tubular member having a proximal end anda distal end; a middle tubular member having a proximal end and a distalend, the middle tubular member configured to be received within theouter tubular member and capable of being rotatable relative to theouter tubular member; an inner tubular member configured to be receivedwithin the middle tubular member and capable of reciprocating and alsocapable of being rotatable relative to the middle tubular member; afirst opening with a cutting surface disposed at the distal end of theouter tubular member; and a first window disposed between the distal endand the proximal end of the outer tubular member; a second opening witha cutting surface disposed at the distal end of the middle tubularmember, a second window disposed between the distal end and the proximalend of the middle outer tubular member; wherein the first opening andthe second opening are configured to form a cutting tool when the middletubular member rotates relative to the outer tubular member, and whereinthe inner tubular member is configured to form another cutting toolwhile it reciprocates and rotates relative to the middle tubular memberwhen it is exposed by a superimposition of the first window and thesecond window.

A device as above wherein the outer tubular member is configured toremain stationary during operation.

A device as above wherein the middle tubular member is configured tooscillate, or rotate in only one direction, within the outer tubularmember.

A device as above wherein the distal end of the middle tubular member isbetween the proximal end and distal end of the outer tubular member.

It should be understood that components of the invention can beoperationally coupled or connected and that any number or combination ofintervening elements can exist (including no intervening elements). Theconnections can be direct or indirect and additionally there can merelybe a functional relationship between components.

It should be understood that the foregoing description is onlyillustrative of the invention. Various alternatives and modificationscan be devised by those skilled in the art without departing from theinvention. Accordingly, the invention is intended to embrace all suchalternatives, modifications and variances which fall within the scope ofthe appended claims.

What is claimed is:
 1. A medical device, the device comprising: an outertubular member; a middle tubular member, the middle tubular memberconfigured to be rotatable relative to the outer tubular member; and aninner tubular member configured to reciprocate and rotate relative tothe middle tubular member; wherein the outer tubular member comprises afirst opening, wherein the middle tubular member comprises a secondopening, wherein the first opening is aligned with the second opening,wherein the outer tubular member comprises a first window proximate thefirst opening, wherein the middle tubular member comprises a secondwindow proximate the second opening, wherein the inner tubular member isconfigured to reciprocate and rotate while the middle tubular member andthe outer tubular member are configured to be stationary, and whereinthe middle tubular member is configured to be rotatable relative to theouter tubular member while the inner tubular member is configured to bestationary.
 2. A medical device as in claim 1 wherein the middle tubularmember is configured to be received within the outer tubular member. 3.A medical device as in claim 1 wherein the inner tubular member isconfigured to be received within the middle tubular member.
 4. A medicaldevice as in claim 1 wherein the first window and the second window arealigned with each other.
 5. A cutting device for cutting tissue, thedevice comprising: an outer tubular member having a first opening; amiddle tubular member having a second opening, the middle tubular memberconfigured to be rotatable relative to the outer tubular member; and aninner tubular member configured to reciprocate and rotate relative tothe middle tubular member; wherein the outer tubular member comprises afirst window proximate the first opening, wherein the middle tubularmember comprises a second window proximate the second opening, whereinthe first opening and the second opening are configured to form acutting tool when the middle tubular member rotates relative to theouter tubular member while the inner tubular member is configured to bestationary.
 6. A cutting device as in claim 5 wherein the outer tubularmember is configured to remain stationary during operation.
 7. A cuttingdevice as in claim 5 wherein the middle tubular member configured to bereceived within the outer tubular member and wherein the inner tubularmember configured to be received within the middle tubular member.
 8. Acutting device as in claim 5 wherein the first window and the secondwindow are aligned with each other.
 9. A cutting device for cuttingtissue, the device comprising: an outer tubular member having a firstopening; a middle tubular member having a second opening, the middletubular member configured to be rotatable relative to the outer tubularmember; and an inner tubular member configured to reciprocate and rotaterelative to the middle tubular member; wherein the middle tubular memberand the outer tubular member are configured to be stationary when theinner tubular member reciprocates and rotates relative to the middletubular member while the first opening and the second opening are facingin opposite directions to form a closed configuration such that noliquid can flow through the first opening.
 10. A cutting device as inclaim 9 wherein the outer tubular member comprises a first windowproximate the first opening, wherein the middle tubular member comprisesa second window proximate the second opening.
 11. A cutting device as inclaim 10 wherein the first window and the second window are aligned witheach other.
 12. A cutting device as in claim 9 wherein a distal end ofthe middle tubular member is between a proximal end and a distal end ofthe outer tubular member.
 13. A cutting device for cutting tissue, thedevice comprising: an outer tubular member having a first opening withcutting surface; a middle tubular member having a second opening withcutting surface, the middle tubular member configured to be rotatablerelative to the outer tubular member; and an inner tubular memberconfigured to reciprocate and rotate relative to the middle tubularmember; wherein the first opening and the second opening are configuredto form one cutting tool while the inner tubular member is configured tobe stationary, wherein the inner tubular member is configured toreciprocate and rotate while the middle tubular member and the outertubular member are configured to be stationary, and wherein the firstopening and the second opening are configured to form a closedconfiguration when the openings are facing in opposite directions suchthat no liquid can flow through the first opening.
 14. A cutting deviceas in claim 13 wherein the middle tubular member configured to bereceived within the outer tubular member, and wherein the inner tubularmember configured to be received within the middle tubular member.
 15. Acutting device as in claim 13 wherein the outer tubular member comprisesa first window proximate the first opening, and wherein the middletubular member comprises a second window proximate the second opening.16. A cutting device as in claim 15 wherein the first window and thesecond window are aligned with each other.
 17. A cutting device forcutting tissue, the device comprising: an outer tubular member having afirst opening and a first window, wherein the first opening comprises acutting surface; a middle tubular member having a second opening and asecond window, wherein the second opening comprises a cutting surface,wherein the middle tubular member is configured to be rotatable relativeto the outer tubular member; and an inner tubular member configured toreciprocate and rotate relative to the middle tubular member; whereinthe first opening and the second opening are configured to form acutting tool when the middle tubular member rotates relative to theouter tubular member, and wherein the inner tubular member is configuredto form another cutting tool while it reciprocates and rotates relativeto the middle tubular member when it is exposed by a superimposition ofthe first window and the second window.
 18. A cutting device as in claim17 wherein the outer tubular member is configured to remain stationaryduring operation.
 19. A cutting device as in claim 17 wherein the middletubular member is configured to oscillate, or rotate in only onedirection, within the outer tubular member.
 20. A cutting device as inclaim 17 wherein a distal end of the middle tubular member is between aproximal end and a distal end of the outer tubular member.